RESULTS OF A PILOT IMPLEMENTATION OF AN ADL GUIDELINE FOR NURSING PROFESSIONALS IN THE NETHERLANDS

Abstract Nursing care in activities of daily living (ADL), such as washing, dressing, or eating is frequently provided while being poorly informed by scientific evidence. To address nursing professionals’ need for guidance we developed a practice guideline on ADL-care. This guideline comprises eleven core recommendations on involving care receivers and informal caregivers in ADL-care, identifying ADL-care needs, and effective ADL-interventions. Since the success of this guideline hinges on its actual use by nursing professionals, we assessed the use and determined influencing factors to guide targeted strategies for future implementation in different nursing care settings. In a mixed-method study, nursing professionals documented the number of core recommendations applied over three weeks using recording forms and a self-administered questionnaire to identify barriers and facilitators. In addition, we conducted focus groups to capture team experiences in applying the 11 core recommendations and clarifying survey results. Seven nursing care teams participated from various settings: hospital (n=1), rehabilitation (n=2), home-care (n=1), and long-term care (n=3). Preliminary results reveal that participants consider the core recommendations compatible with and adaptable to current practices, and their care settings. Participants experienced advantages over existing practices. However, core-recommendation usage and perception of influencing factors appeared to be highly context-dependent, especially regarding the involvement of informal caregivers in ADL-care. Limited knowledge on the application of interventions to improve ADL limited the use of some recommendations. Our results underline the necessity of careful selection of targeted strategies for each setting tailoring the core recommendations to the different qualifications and roles of nursing professionals.

work for research in the older adult population. Over 40% of older adults experience polypharmacy, which can be addressed by deprescribing unnecessary medications. This review aimed to assess the degree to which the 4Ms were considered in intervention design, sample selection, and outcome assessment in deprescribing trials by keyword search in six databases and snowballing. Thirty-seven of the 564 trials identified met the review eligibility criteria. Imbalanced consideration of 4Ms in the deprescribing trials was observed. Intervention design: "Medication" was considered in all trials; "Mentation" was considered in 8 trials; "Mobility" (n=2) and "What Matters" (n=6) was less often considered. By targeting providers, most of the trials lacked consideration of patient-centeredness -aligning what matters most to older adults and their families with deprescribing decision making and implementation. Sample selection: "Medication" was considered in 15 trials (e.g., samples including patients taking ≥ 5 medications or specific types of medications), whereas "Mentation" (n=6), "Mobility" (n=6) and "What Matters" (n=0) were less often considered. Outcome assessment: "Medication" was the most commonly assessed outcomes (n=33), followed by "Mobility" (n=13) and "Mentation" (n=10) outcomes, with no study examining "What Matters" outcomes. 4Ms were not purposefully considered in the intervention design, sample selection, and outcome measurement of existing deprescribing trials. Future deprescribing trials need a more balanced and complete consideration of the 4Ms in the trial design and implementation.

HIGH-RISK ELDERLY SCREENING IN MEDICAL INTENSIVE CARE UNIT
Gowrishankar Gnanasekaran 1 , and Narendrakumar Alappan 2 , 1. Cleveland Clinic Foundation,Cleveland,Ohio,United States,2. Fairview Hospital,Cleveland Clinic,Cleveland,Ohio,United States Geriatrics care in medical intensive care units (MICU) establishes a unique opportunity in early screening of High Risk Elderly (HRE) patients admitted for critical care. Many MICUs do not have a standard protocol to screen for HRE patients as part of their daily huddle. Our program is a quality improvement initiative to improve early identification of HRE patients in the MICU. HRE patients were identified based on nursing specific screening triggers at one of the Regional Hospitals of a large teaching hospital in Northeast Ohio.The program was designed as a part of geriatrics care expansion at regional hospital sites. Identified patients were discussed in daily huddles to determine unique geriatric needs in caring for these patients. A geriatrics co-management team was engaged in comprehensive geriatric assessments and care transition when it was needed. Geriatrics care in MICU demonstrates a unique opportunity in early identification of HRE patients. This helps to support a patient -centered approach in caring for critically ill elderly patients. The program would lay foundations in early screening for risk factors and optimizing elderly care in MICU.

RESULTS OF A PILOT IMPLEMENTATION OF AN ADL GUIDELINE FOR NURSING PROFESSIONALS IN THE NETHERLANDS
Svenja Cremer 1 , Michel Bleijlevens 1 , Silke Metzelthin 1 , Janneke de Man-van Ginkel 2 , and Sandra Zwakhalen 1 , 1.

Maastricht University, Maastricht, Limburg, Netherlands, 2. Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
Nursing care in activities of daily living (ADL), such as washing, dressing, or eating is frequently provided while being poorly informed by scientific evidence. To address nursing professionals' need for guidance we developed a practice guideline on ADL-care. This guideline comprises eleven core recommendations on involving care receivers and informal caregivers in ADL-care, identifying ADL-care needs, and effective ADL-interventions. Since the success of this guideline hinges on its actual use by nursing professionals, we assessed the use and determined influencing factors to guide targeted strategies for future implementation in different nursing care settings. In a mixed-method study, nursing professionals documented the number of core recommendations applied over three weeks using recording forms and a self-administered questionnaire to identify barriers and facilitators. In addition, we conducted focus groups to capture team experiences in applying the 11 core recommendations and clarifying survey results. Seven nursing care teams participated from various settings: hospital (n=1), rehabilitation (n=2), home-care (n=1), and long-term care (n=3). Preliminary results reveal that participants consider the core recommendations compatible with and adaptable to current practices, and their care settings. Participants experienced advantages over existing practices. However, corerecommendation usage and perception of influencing factors appeared to be highly context-dependent, especially regarding the involvement of informal caregivers in ADL-care. Limited knowledge on the application of interventions to improve ADL limited the use of some recommendations. Our results underline the necessity of careful selection of targeted strategies for each setting tailoring the core recommendations to the different qualifications and roles of nursing professionals. Studies have shown that health education can improve dietary intake, exercise, and energy balance, which improves health outcomes and quality of life. However, diverse low-income older adults may have low self-efficacy coupled with potentially negative opinions regarding the aging process. Emerging research suggests that asset-based approaches utilizing persuasive and hopeful messages may be particularly effective with diverse populations of older adults who may be struggling with negative perceptions of self-efficacy. Research also shows that health behavior change interventions are most likely to be successful among diverse populations when they incorporate messages of resilience and facilitate information sharing and diffusion among participants. This presentation outlines the program curriculum development process of a student-led health promotion program by an interdisciplinary team of university researchers. Public health, dietetics, and communication faculty utilized Persuasive Hope Theory (PHT) and Self-Efficacy Theory to create a 15-week program to improve fruit and vegetable intake and physical activity among low-income adults aged 55+ living in Anchorage, Alaska. We will also detail the curricular components for this NIA-funded program which will be delivered in Fall 2022.

A DEDICATED APPROACH TO PALLIATIVE DEMENTIA CARE
Judith Meijers 1 , Sascha Bolt 2 , Sandra Zwakhalen 1 , Chandni Khemai 1 , Jos Schols 1 , Daisy Janssen 1 , Jenny van der Steen 3 , and Jesper Biesmans 4 , 1. Maastricht University,Maastricht,Limburg,Netherlands,2. Tilburg University,Tilburg,Netherlands,3. Leiden University Medical Center,Leiden,Netherlands,4. Zuyderland,Zuyderland,Limburg,Netherlands Nursing staff play a central role in the palliative care for people with dementia. Development of their palliative care competences may support timely recognition and addressing of individual needs of persons with dementia and their family caregivers in long term care. In the DEDICATED (Desired Dementia Care Towards End of Life) project, we aim to develop materials to support nursing staff in providing palliative dementia care. The first step of the project concerned a needs assessment, mapping the perspectives of nursing staff, family caregivers and people with dementia (scoping review, surveys and semi-structured interviews). Using these studies' results as a starting point, an intervention (the DEDICATED approach) was built, using an iterative co-creation approach involving nursing staff and educators (N=12). These 'ambassadors' were also trained to disseminate the approach within their care teams and nursing curricula. First reactions from the pilot study regarding the DEDICATED-materials are positive and nurses and nurse educators are eager to use the materials (www.dedicatedwerkwijze.nl). Currently the DEDICATED-approach is being evaluated using a mixed methods pretest-posttest controlled design comparing three groups: a design group (12 wards), a test group (28 wards, 28 new-trained ambassadors) and a control group (12 wards). The main outcomes of study are e.g. self-efficacy, empowerment and engagement in providing palliative care for people with dementia. A secondary outcome involves longitudinal trends of the quality of dying of persons with dementia within the group. Older adults residing in long-term care (LTC) settings are at an increased risk of poor oral health due to comorbidities and limited ability to provide self-care. Routine oral care is essential for maintaining overall health. Coupled with resident vulnerability is a traditional lack of training and focus on oral health care in LTC. MOTIVATE (Maine's Oral Team-Based Initiative: Vital Access to Education) is a pilot (N = 8 sites) interprofessional education program focused on daily oral health care within LTC, providing education and technical assistance to advance staff knowledge, skills, and attitudes about oral health. An evaluation was carried out using a pre/post survey design with instruments administered immediately before and after learning module completion along with a survey administered one month after implementation. Knowledge, attitudes, and oral health practices were assessed. A statistical comparison between baseline (N = 491) and post-launch (N = 215) scores revealed a statistically significant improvement (p < 0.001) across all knowledge and attitudes measures including the perceived importance of oral health, understanding of interprofessional roles among